• 제목/요약/키워드: Trauma outcome

검색결과 270건 처리시간 0.022초

The Prognosis of Traumatic Small Bowel Injury Accompanied by Liver Injury

  • Noh, Yu Seong;Jung, Sung Won;Heo, Tae Gil;Choi, Pyong Wha;Kim, Jae Il;Jun, Heung Man;Shin, Yong Chan;Jung, Sung Min;Um, Eun Hae
    • Journal of Trauma and Injury
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    • 제34권1호
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    • pp.44-49
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    • 2021
  • Purpose: The aim of this study was to elucidate the prognosis, and other clinical features, such as time to surgery and the amount of transfusion, of small bowel injury (SBI) accompanied by liver injury (LI). Methods: We investigated 221 patients with SBI who visited an emergency center from October 2000 to March 2019. We excluded patients with injuries that directly led to mortality, and the remaining 149 patients were divided into the SBI alone (SBI-A) group and the SBI accompanied by LI (SBI-LI) group. Data were collected for preoperative and surgical outcome variables, and the treatment results were compared between groups. Results: The SBI-LI group had a higher mortality rate than the SBI-A group (22.4% vs. 14.3%), but this difference was not statistically significant (p=0.061). There were no significant differences between the SBI-A and SBI-LI groups, except for the amount of red blood cell (RBC) transfusion (SBI-A: 3.53±0.1 vs. SBI-LI: 8.38±0.7 packs, p=0.035) and the length of intensive care unit (ICU) stay (SBI-A: 6.7±0.2 vs. SBI-LI: 11.1±0.5 days, p=0.047). Conclusions: The SBI-LI group required more RBC transfusions and longer ICU stays than the SBI-A group. SBI accompanied by LI may show higher mortality than SBI alone; however, since the difference was not statistically significant in the present study, larger-scale follow-up research is needed.

The effect of neuropathic pain on quality of life, depression levels, and sleep quality in patients with combat-related extremity injuries

  • Atar, Merve Orucu;Kamaci, Gizem Kilinc;Ozcan, Fatma;Demir, Yasin;Aydemir, Koray
    • Journal of Trauma and Injury
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    • 제35권3호
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    • pp.202-208
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    • 2022
  • Purpose: There is limited research on the effects of neuropathic pain (NP) on quality of life, depression levels, and sleep quality in patients with combat-related extremity injuries. This study evaluated whether patients with combat-related extremity injuries with and without NP had differences in quality of life, sleep quality, and depression levels. Methods: A total of 98 patients with combat-related extremity injuries, 52 with NP and 46 without, were included in this cross-sectional study. The presence of NP was determined using the Leeds Assessment of Neuropathic Symptoms and Signs questionnaire. The outcome measures were a visual analogue scale (VAS), the 36-Item Short Form Survey, the Beck Depression Inventory, and the Pittsburgh Sleep Quality Index (PSQI). Results: The VAS subparameter scores for pain (all P<0.05), PSQI sleep dur ation subscale scores (P=0.025), PSQI sleep disturbance subscale scores (P=0.016), and PSQI total scores (P=0.020) were significantly higher in patients with NP than those without. Logistic regression analysis showed that VAS scores of 5 and above for average pain during the previous 4 weeks contributed independently to the prediction of NP. Conclusions: Patients with combat-related extremity injuries with NP had more pain and poorer sleep quality than those without NP. Sleep quality should be evaluated as part of the diagnostic work-up in patients with combat-related extremity injury with NP, and interventions to improve sleep quality may help manage NP in this patient group.

The Great Saphenous Vein-An Underrated Recipient Vein in Free Flap Plasty for Lower Extremity Reconstruction: A Retrospective Monocenter Study

  • Meiwandi, Abdulwares;Kamper, Lars;Kuenzlen, Lara;Rieger, Ulrich M.;Bozkurt, Ahmet
    • Archives of Plastic Surgery
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    • 제49권5호
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    • pp.683-688
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    • 2022
  • Background Reconstruction of large soft tissue defects of the lower extremity often requires the use of free flaps. The main limiting factor and potential for complications lie in the selection of proper donor and recipient vessels for microvascular anastomosis. While the superficial veins of the lower leg are easier to dissect, they are thought to be more vulnerable to trauma and lead to a higher complication rate when using them instead of the deep accompanying veins as recipient vessels. No clear evidence exists that proves this concept. Methods We retrospectively studied the outcomes of 97 patients who underwent free flap plasty to reconstruct predominantly traumatic defects of the lower extremity at our institute. The most used flap was the gracilis muscle flap. We divided the population into three groups based on the recipient veins that were used for microvascular anastomosis and compared their outcomes. The primary outcome was the major complication rate. Results Overall flap survivability was 93.81%. The complication rates were not higher when using the great saphenous vein as a recipient vessel when comparing to utilizing the deep concomitant veins alone or the great saphenous vein in combination to the concomitant veins. Conclusions In free flap surgery of the lower extremity, the selection of the recipient veins should not be restricted to the deep accompanying veins of the main vessels. The superficial veins, especially the great saphenous vein, offer an underrated option when performing free flap reconstruction.

Clinical Characteristics and Current Managements for Patients with Chronic Subdural Hematoma : A Retrospective Multicenter Pilot Study in the Republic of Korea

  • Oh, Hyuk-Jin;Seo, Youngbeom;Choo, Yoon-Hee;Kim, Young Il;Kim, Kyung Hwan;Kwon, Sae Min;Lee, Min Ho;Chong, Kyuha
    • Journal of Korean Neurosurgical Society
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    • 제65권2호
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    • pp.255-268
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    • 2022
  • Objective : Chronic subdural hematoma (CSDH) is a common disease in neurosurgical departments, but optimal perioperative management guidelines have not yet been established. We aimed to assess the current clinical management and outcomes for CSDH patients and identify prognostic factors for CSDH recurrence. Methods : We enrolled a total of 293 consecutive patients with CSDH who underwent burr hole craniostomy at seven institutions in 2018. Clinical and surgery-related characteristics and surgical outcomes were analyzed. The cohort included 208 men and 85 women. Results : The median patient age was 75 years. Antithrombotic agents were prescribed to 105 patients. History of head trauma was identified in 59% of patients. Two hundred twenty-seven of 293 patients (77.5%) had unilateral hematoma and 46.1% had a homogenous hematoma type. About 70% of patients underwent surgery under general anesthesia, and 74.7% underwent a single burr hole craniostomy surgery. Recurrence requiring surgery was observed in 17 of 293 patients (5.8%), with a median of 32 days to recurrence. The postoperative complication rate was 4.1%. In multivariate analysis, factors associated with CSDH recurrence were separated hematoma type (odds ratio, 3.906; p=0.017) and patient who underwent surgery under general anesthesia had less recurrence (odds ratio, 0.277; p=0.017). Conclusion : This is the first retrospective multicenter generalized cohort pilot study in the Republic of Korea as a first step towards the development of Korean clinical practice guidelines for CSDH. The type of hematoma and anesthesia was associated with CSDH recurrence. Although the detailed surgical method differs depending on the institution, the surgical treatment of CSDH was effective. Further studies may establish appropriate management guidelines to minimize CSDH recurrence.

Characteristics of injuries associated with electric personal mobility devices: a nationwide cross-sectional study in South Korea

  • Kim, Maro;Suh, Dongbum;Lee, Jin Hee;Kwon, Hyuksool;Choi, Yujin;Jeong, Joo;Kim, Sola;Hwang, Soyun;Park, Joong Wan;Jo, You Hwan
    • Journal of Trauma and Injury
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    • 제35권1호
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    • pp.3-11
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    • 2022
  • Purpose: The increasing use of electric personal mobility devices (ePMDs) has been accompanied by an increasing incidence of associated accidents. This study aimed to investigate the characteristics of ePMD-related injuries and their associated factors. Methods: This cross-sectional study was conducted using data from the Emergency Department-based Injury In-depth Surveillance database from 2014 to 2018. All patients who were injured while operating an ePMD were eligible. The primary outcome was the rate of severe injury, defined as an excess mortality ratio-adjusted Injury Severity Score of ≥25. We calculated the adjusted odds ratios (AORs) of outcomes associated with ePMD-related injuries. Results: Of 1,391,980 injured patients, 684 (0.05%) were eligible for inclusion in this study. Their median age was 28 years old, and most injuries were sustained by men (68.0%). The rate of ePMD-related injuries increased from 3.1 injuries per 100,000 population in 2014 to 100.3 per 100,000 population in 2018. A majority of the injuries occurred on the street (32.7%). The most commonly injured area was the head and face (49.6%), and the most common diagnosis was superficial injuries or contusions (32.9%). Being aged 55 years or older (AOR, 3.88; 95% confidence interval, 1.33-11.36) and operating an ePMD while intoxicated (AOR, 2.78; 95% confidence interval, 1.52-5.08) were associated with severe injuries. Conclusions: The number of emergency room visits due to ePMD-related injuries is increasing. Old age and drunk driving are both associated with serious injuries. Active traffic enforcement and safety regulations regarding ePMDs should be implemented to prevent severe injuries caused by ePMD-related accidents.

천장관절융합술 후 기능 회복에 대한 추나요법을 포함한 한의복합치료 증례보고 1례 (A Case Report of Complex Korean Medicine Treatment Application Including Chuna Manual Therapy for Functional Recovery After Sacroiliac Joint Fusion)

  • 한윤희;박신혁;우현준;하원배;이정한
    • 척추신경추나의학회지
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    • 제17권2호
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    • pp.63-72
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    • 2022
  • Objectives This case study aimed to investigate the effect of complex Korean medicine treatment including Chuna manual therapy on sacroiliac joint (SIJ) pain status post SIJ fusion with sacroiliac screw fixation. Methods Complex Korean medicine treatments including Chuna manual therapy were provided to patients with SIJ widening due to a traffic accident trauma. Measurement of range of motion and manual muscle test to evaluate functional activities of daily living was conducted before and after treatment. Moreover, outcome estimates were performed using the numeric rating scale, pain disability index, and EuroQol 5-dimension five-level questionnaire. Results After complex treatment, functional activities of daily living improved. Sacroiliac joint pain decreased and the quality-of-life score improved. Conclusions This study suggests that treatment with complex Korean medicine treatment including Chuna manual therapy may improve traumatic SIJ widening status post SIJ fusion. A postoperative rehabilitation protocol based on accumulated research results considering a multidisciplinary approach should be prepared to ensure holistic treatment.

Comparison of hybrid arch bar versus conventional arch bar for temporary maxillomandibular fixation during treatment of jaw fractures: a prospective comparative study

  • Samriddhi Burman;Santhosh Rao;Ankush Ankush;Nakul Uppal
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제49권6호
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    • pp.332-338
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    • 2023
  • Objectives: This study aimed to compare the effectiveness of a hybrid arch bar (hAB) with the conventional Erich arch bar (EAB) for the management of jaw fractures, focusing on their use for temporary fixation in patients undergoing open reduction and internal fixation (ORIF). Materials and Methods: Patients presenting with maxillary and mandibular fractures at our institution were included in this prospective, comparative study. Placement time and ease of occlusal reproducibility were recorded intraoperatively for Group A (hAB patients) and Group B (EAB patients). The primary outcome was comparison of the postoperative stability of the two arch bars. Postoperative measurements also included mucosal overgrowth, screw loosening or wire retightening, and replacement rates. The data were tabulated and computed with a P<0.05 considered statistically significant. Results: The study included 41 patients. A statistically significant difference was observed in postoperative stability scores (3) between Group A and Group B (85.0% vs 9.5%, P=0.001). The mean placement time in Group A (23.3 minutes) significantly differed from that in Group B (86.4 minutes) (P<0.001). The ease of intraoperative occlusion was not different between the two groups (P=0.413). Mucosal overgrowth was observed in 75.0% of patients (15 of 20) in Group A. Conclusion: The hAB was superior to EAB in clinical efficiency, maxillomandibular fixation time reduction, stability, versatility, and safety. Despite temporary mucosal overgrowth, the benefits of hAB outweigh the disadvantages. The choice between hAB and EAB should be based on specific clinical requirements.

응급실에 내원하는 개와 고양이의 주증과 원인에 대한 후향분석: 3,180례 (Retrospective Analysis of Chief Complaints and Causes of Dogs and Cats during Emergency Visits: 3,180 Cases)

  • 이혜경;손원균;서지민;김현욱;이인형
    • 한국임상수의학회지
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    • 제31권2호
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    • pp.90-94
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    • 2014
  • 본 연구는 응급실에 내원하는 개와 고양이의 흔한 주증과 원인을 파악하고, 응급진료를 제공하는 한국의 응급 동물병원에 필요한 최소한의 준비 사항을 제안하고자 실시되었다. 해마루 이차진료 동물병원의 응급실에 2012년 3월부터 2013년 8월 사이에 내원한 2,368마리의 개와 347마리의 고양이를 대상으로 진료 기록을 분석하였다. 그 중, 255마리의 개와 35마리의 고양이는 두 번 이상 응급실에 내원하였으며, 이들은 각각의 내원을 하나의 증례로 취급하였다. 따라서 개에서 총 2,784증례와 고양이에서 396증례를 분석하였다. 진료 기록에서는 품고, 주증, 진단, 입원 여부, 생존여부를 분석하였다. 개의 주증으로는 구토, 설사 혹은 두 가지 모두인 경우가 가장 많았으며, 다음으로는 호흡곤란, 외상, 발작, 기력저하 순이었다. 개에서 가장 많이 진단된 질환은 소화기계 질환이었으며, 그 다음으로는 신경계 질환, 심혈관계 질환, 호흡기계 질환, 비뇨기계 질환, 혈액 질환 순이었다. 고양이에서의 주증으로는 호흡곤란이 가장 많았으며, 다음으로는 구토, 설사 혹은 두 가지 모두, 외상, 배뇨곤란, 기력저하 순이었다. 고양이에서 가장 많이 진단된 질환은 비뇨기계 질환이었으며, 그 다음으로는 소화기계 질환, 호흡기계 질환, 감염성 질환, 심혈관계 질환 순이었다. 본 연구의 결과에 따르면, 구토, 설사 혹은 두 가지 모두와 호흡곤란, 외상이 개와 고양이 모두에서 가장 흔하게 접하는 주증이었으며, 이 세가지가 전체 증례의 주증 중에서 약 48.6%를 차지하였다. 하지만 흔히 진단되는 질환은 종간 차이를 보였다. 본 연구의 결과를 토대로, 응급한 환자를 진단하고 안정시킬 수 있는 적절한 응급 진료를 제공하기 위해서 필요한 최소 준비 사항은 충분한 지식을 갖춘 숙련된 인력과 응급 처치와 진단이 가능한 시설을 갖추는 것임을 확인할 수 있었다.

제 2형 SLAP 병변의 외상 유무에 따른 손상 기전 및 치료 결과의 분석 (Evauation of Injury Mechanism and Clinical Outcome Between Non-Traumatic and Traumatic Type II Slap Lesions)

  • 김용주;정훈;하종경;이관희;최성현
    • Clinics in Shoulder and Elbow
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    • 제13권2호
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    • pp.244-249
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    • 2010
  • 목적: 본 연구는 제 2형 SLAP 병변에서 외상의 유무에 따른 손상기전의 차이 및 임상 결과의 차이를 비교하고자 한다. 대상 및 방법: 2007년 1월부터 2009년 5월까지 제 2형 SLAP 단독 병변으로 수술을 시행한 27예를 대상으로 하였다. 제 2형 SLAP 병변의 분류는 Burkhart에 의한 분류법을 이용하여 병변이 전상방부에 위치하면 제 1형, 후상방부는 제 2형, 전후방 복합 병변은 제 3형으로 분류하였다. 치료 결과는 술 전, 술 후의 UCLA 점수와 KSS 점수를 사용하여 측정하였다. 결과: 총 27예 중 외상군은 16예, 비외상군은 11예였다. 제 2형 SLAP 병변의 형태는 외상군에서 제 1형은 12예, 제 2형은 2예 그리고 제 3형은 2예였다(p=0.013). 비외상군에서는 제 1형 2예, 제 2형 6예, 제 3형 3예였다 (p=0.026). 즉 외상군에서는 전방 병변이 더 많이 발생하였고 (p<0.05), 비외상군에서는 후방 병변이 더 많이 발생한 것으로 추정할 수 있다 (p<0.05). 외상군에서 UCLA 점수 및 KSS 점수는 술 전 평균 18점 (14~23점), 48점 (32~76점)에서 술 후 32점 (28~33), 86점 (71~92점)이었다. 비외상군에서는 UCLA 점수 및 KSS 점수는 술 전 평균 21점 (18~25점), 58점 (41~68점)에서 술 후 29점 (26~31점), 81점 (68~89점)이었다. 임상결과에 있어서 두 군 사이의 통계학적으로 유의한 차이를 보이지 않았다 (p=0.317, 0.405). 결론: 본 연구에서 제 2형 SLAP 병변의 형태가 외상 기전에 따라 차이가 있음을 관절경 소견을 통해 확인할 수 있었다. 따라서 제 2형 SLAP 병변에 대한 수술적 치료를 고려할 때 외상 유무를 파악하여야 할 것이다.

선택적 함구증 아동의 임상특성 및 치료경과 (CLINICAL CHARACTERISTICS AND TREATMENT COURSES OF THE CHILDREN WITH SELECTIVE MUTISM)

  • 정선주;홍강의
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제6권1호
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    • pp.74-89
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    • 1995
  • 본 연구는 DSM-IV에 의해 선택적 함구증으로 진단된 23명의 아동들을 대상으로 임상적인 특성(인구학적 특성, 임상경과, 발달력, 성격특성, 가족력, 지능지수, 학업성취도), 치료방법 및 기간, 치료경과등을 조사하여 다음과 같은 결과를 얻었다. 1) 대상군의 남녀 비율은 1 : 4.8로 여아에서 높았으며 발병시 평균연령을 3세 4개월, 치료시작의 평균연령은 7세 7개월이었다. 2) 주산기의 문제를 가지고 있었던 아동은 22%였으며 언어발달이 지연되었던 아동은 26%였다. 3세 이전에 주 양육자와의 분리경험이 있던 아동은 26%, 3세 이전에 외상이나 심리적 충격을 입었던 아동은 26%였다. 유뇨증의 병력은 30%에서, 유분증의 병력은 4%에서 있었다. 3) 어머니의 공생적인(symbiotic relationship) 관계에 있는 아동은 61%였고 가정내에서 아버지보다 어머니의 영향력이 우세한 경우는 65%였다. 부모중 정신병리나 알콜/약물중독의 문제를 가지고 있는 경우는 39%였다. 과거력상 신체적인 학대를 받았던 아동은 26%였다. 4) 환아들의 성격특성중 가장 많은 것은 수줍음(100%)이었고 그 다음으로는 불안해 한다(83%), 고집이 세다(83%), 아기 같고 의존적이다(65%), 화를 잘 낸다(52%), 조종하려고 한다(39%) 순으로 많았다. 5) 지능검사를 실시한 16명 아동의 평균 지능지수는 88.3이었고 이중 정신지체의 기준은 IQ 69 이하의 아동이 7명, 70 이상인 아동아 9명이었다. 6) 치료방법중 놀이치료를 받은 아동이 65%로 가장 많았으며 약물치료를 받은 아동은 21%, 행동치료를 받은 아동은 8%, 한 가지 이상의 방법을 복합하여 치료받은 아동은 12%였다. 7) 치료종료시 최우수 평가를 받은 아동은 8.6% 였고 우수의 평가를 받은 아동은 30.4% 양호의 평가를 받은 아동은 52%, 불량의 평가를 받은 아동은 8.7%였다. 추적도사의 최우수의 평가를 받은 아동은 21.7%였고 우수는 13%, 양호는 21.7%, 불량은 34.8% 였다. 치료성과는 유의미한 상관관계를 보이는 변수는 지능지수로 나타났다. 8) 대상군을 공생형 함구증(symbiotic mutism), 언어공포성 함구증(speech phobic mutism), 반응성 함구증(reactive mutism), 수동-공격성 함구증(passive aggressive mutism)으로 분류하였을때 각각 65%, 8.6%, 12%, 30%였다. 지능지수에 따라 정신지체로 분류된 7명과 정상지능군에 속하는 9명을 비교적 언어발달 및 성격특성, 가족역동, 치료성과 등에서 차이가 있음을 알 수 있었다.

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